Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2014 Musculoskeletal Infection Society 11 articles


Liposomal Formulation Decreases Toxicity of Amphotericin B In Vitro and In Vivo

Justin Roberts MD, Josh Bingham MD, Alex C. McLaren MD, Ryan McLemore PhD

Liposomal amphotericin B is locally delivered to treat fungal orthopaedic infections but little is known about local tissue toxicity, if any, that might be associated with local delivery.

Twenty Percent of Patients May Remain Colonized With Methicillin-resistant Staphylococcus aureus Despite a Decolonization Protocol in Patients Undergoing Elective Total Joint Arthroplasty

Michael D. Baratz MD, Ruth Hallmark BSN, Susan M. Odum PhD, Bryan D. Springer MD

is the most commonly isolated organism in periprosthetic joint infection (PJI). Resistant strains such as methicillin-resistant(MRSA) are on the rise, and many programs have instituted decolonization protocols. There are limited data on the success ofnasal decolonization programs and their impact on PJI.

A History of Treated Periprosthetic Joint Infection Increases the Risk of Subsequent Different Site Infection

Hany Bedair MD, Nitin Goyal MD, Mathew J. Dietz MD, Kenneth Urish MD, PhD, Viktor Hansen MD, Jorge Manrique MD, William Hamilton MD, Greg Deirmengian MD

After the successful treatment of periprosthetic joint infection (PJI), patients may present with degenerative joint disease in another joint with symptoms severe enough to warrant arthroplasty. However, it is not known whether patients with a history of treated PJI at one site will have an increased risk of PJI in the second arthroplasty site.

Are Nucleated Cell Counts Useful in the Diagnosis of Infection in Periprosthetic Fracture?

Stephen Preston MD, Lyndsay Somerville PhD, Brent Lanting MD, James Howard MD

Evaluating for the possibility of prosthetic joint infection in the setting of periprosthetic fracture is important because it determines the course of treatment. However, fracture-related inflammation can make investigations used in the diagnosis of infection less reliable.

Antimicrobial Release From Prefabricated Spacers Is Variable and the Dose Is Low

Oren Goltzer MD, Alex McLaren MD, Derek Overstreet PhD, Christopher Galli BS, Ryan McLemore PhD

High-dose antimicrobial-loaded bone cement (ALBC) is recommended to treat orthopaedic infections. Elution characteristics from prefabricated ALBC spacers and how they compare with hand-mixed ALBC are not well described.

The Alpha-defensin Test for Periprosthetic Joint Infection Responds to a Wide Spectrum of Organisms

Carl Deirmengian MD, Keith Kardos PhD, Patrick Kilmartin MS, Simmi Gulati MS, Patrick Citrano BS, Robert E. Booth MD

The alpha-defensin test has been previously demonstrated to be highly accurate in the diagnosis of prosthetic joint infection (PJI), nearly matching the Musculoskeletal Infection Society definition for PJI. However, the relationship between alpha-defensin levels and differing infecting organism has not yet been investigated.

Premature Therapeutic Antimicrobial Treatments Can Compromise the Diagnosis of Late Periprosthetic Joint Infection

Alisina Shahi MD, Carl Deirmengian MD, Carlos Higuera MD, Antonia Chen MD, MBA, Camilo Restrepo MD, Benjamin Zmistowski MD, Javad Parvizi MD

In the absence of positive cultures and draining sinuses, the diagnosis of periprosthetic joint infection (PJI) relies on laboratory values. It is unknown if administration of antibiotics within 2 weeks before diagnostic evaluations can affect these tests in patients with PJI.

Novel Antibiotic-loaded Point-of-care Implant Coating Inhibits Biofilm

Jessica Amber Jennings PhD, Daniel P. Carpenter BS, Karen S. Troxel PhD, Karen E. Beenken PhD, Mark S. Smeltzer PhD, Harry S. Courtney PhD, Warren O. Haggard PhD

Orthopaedic biomaterials are susceptible to biofilm formation. A novel lipid-based material has been developed that may be loaded with antibiotics and applied as an implant coating at point of care. However, this material has not been evaluated for antibiotic elution, biofilm inhibition, or in vivo efficacy.

The Gown-glove Interface Is a Source of Contamination: A Comparative Study

James F. Fraser MD, MPH, Simon W. Young FRACS, Kimberly A. Valentine RN, Nicholas E. Probst PA-C, Mark J. Spangehl MD

The original Charnley-type negative-pressure body exhaust suit reduced infection rates in randomized trials of total joint arthroplasty (TJA) decades ago. However, modern positive-pressure surgical helmet systems have not shown similar benefit, and several recent studies have raised the question of whether these gowning systems result in increased wound contamination and infections. The gown-glove interface may be one source of particle contamination.

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

P. Maxwell Courtney MD, Christopher M. Melnic MD, Zachary Zimmer MD, Jason Anari MD, Gwo-Chin Lee MD

With increasing prevalence of methicillin-resistant(MRSA) in patients undergoing hip and knee arthroplasty, some have advocated a dual-antibiotic regimen including vancomycin as prophylaxis against surgical site infections. However, routine administration of vancomycin may result in impaired renal functions in susceptible patients.